食管嵌顿性异物内镜治疗分析

Endoscopic treatment for foreign body impaction in esophagus

目的评价内镜治疗嵌顿性食管异物的有效性和安全性。方法回顾性总结78例嵌顿性食管异物患者的病例资料，收集食管异物的种类、数量、嵌顿部位、滞留时问，相关食管病变，内镜治疗方法、治疗时间以及并发症发生情况，并对影响并发症发生及治疗时间相关因素进行统计分析。结果食管上段最易发生嵌顿（80．8％，63／78）和穿孔（66．7％，8／12）；11例异物滞留时间超过24h，其余67例不足24h；所有患者经内镜成功取出异物（只有2例穿孔患者取出异物后转耳鼻喉科或胸外科接受进一步治疗），治疗过程中无一例死亡，主要并发症为出血（13例，16．7％），其次为黏膜撕裂伤（7例，9．0％）和穿孔（1例，1．3％），总的并发症发生率为26．9％（21／78）；异物形状、滞留时间及是否穿孑L是影响内镜治疗时间和并发症发生率的主要因素（P〈0．05）。结论内镜治疗嵌顿性食管异物是安全和有效的方法。已造成食管穿孔的异物，滞留时间不超过24h且CT提示食管管腔外无脓肿形成者，可首选内镜治疗。

Objective To assess the efficacy and safety of endoscopic treatment for foreign body impaction in the esophagus. Methods Demographic and endoscopic data of a total of 78 patients with esophagus foreign body impactions were retrospectively studied, which included foreign body types, number, location and duration of impaction, associated esophageal diseases, endoscopic procedures and complications. The factors which influenced the complications and procedure time were also statistically analyzed. Results Impaction （80. 7% ） and perforation （66. 7% ） most frequently occurred in the upper esophagus. Duration of foreign body impaction exceeded 24 hours in 11 patients （ 14. 1% ） , which was less than 24 hours in 67 others （85.9%）. All of the foreign bodies were successfully removed （2 cases of perforation were transferred to other department for further treatment）, and there was no mortality related to endoscopic management occurred. The common complications included mucosal injury, bleeding, and perforation. Shape of the foreign bodies, duration of impaction and status of perforation were the main influential factors on procedure time and complications （P 〈 0. 05）. Conclusion The endoscopic management for esophageal foreign body impaction is safe and effective. It is the first choice for those whose esophagus is perforated with foreign bodies for less than 24 hours and with no abscesses out of esophageal tract.